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Physician Quality Reporting System

Resources to help you to report successfully for the PQRS incentive bonus.

Physicians who do not attempt participation in 2013 will see a 1.5 percent decrease in their 2015 Medicare Part B, Medicare as a secondary payer, and Railroad Medicare payments.

The 2013 incentive payment is 0.5 percent of all your Medicare Part B, Medicare as a secondary payer, and Railroad Medicare allowables, less durable medical equipment and any injected drug.


On this page:

Additional PQRS Topics:


2013 Penalties, Reporting Options and Measure Updates

In 2013 The Centers for Medicare and Medicaid Services (CMS) will use PQRS participation to determine payment cuts in future years.

 

2013

2014

2015

2016

2017

2018

Successful Reporting

.5%

.5%

 

 

 

 

Unsuccessful
Reporting

 

 

-1.5%

-2%

-2%

-2%

Avoid the 2015 Payment Adjustment

Physicians who do not attempt participation in 2013 by reporting at least one PQRS measure, will see a 1.5 percent decrease in their 2015 Medicare Part B, Medicare as a secondary payer, and Railroad Medicare payments. Ophthalmologists of all specialties may participate in PQRS.

Note: Attempting to report means report at least one PQRS measure associated with an exam with dates of service between Jan. 1 and Dec. 31, 2013.

Important: Make sure your remittance advice (RA) has C096 or N365 to verify that the measure(s) have been reported. Remember if the claim is denied, the measure is denied also and will have to be resubmitted.


Achieve the 2013 Payment Incentive

Ophthalmologists who successfully participate in PQRS in 2013 by reporting any three ophthalmic specific measures or submitting data for the cataract measure group, will receive a 0.5 percent payment incentive of all their allowable amounts (less durable medical equipment and any injectable drug) for Medicare Part B, Medicare as a secondary payer, and Railroad Medicare payments.


2013 Reporting Options

  • Option 1: Report 3 measures correctly 50 percent of the time via claims (office base reporting), or
  • Option 2: Report 3 measures correctly 80 percent of the time via CMS approved registry, or
  • Option 3: Report 3 measure correctly 80 percent of the time via CMS approved EHR, or
  • Option 4: Report the cataract group measure through a qualified CMS registry.

Note: For option 2 or 4 the Academy has partnered with Outcome Registry:


2013 Measure Updates

  • Glaucoma staging codes 365.70, 365.71, 365.72, 365.73, 365.74 have been removed from measures 12 and 141.
  • Measure 124: Health Information Technology has been eliminated.
  • Cataract group measure will be 20 surgical patients instead of 30. Of the 20 patients, a majority (11) must be Medicare Part B patients.
       Note: Physicians will be unable to report the cataract measure group until April.
       In addition to mailed surveys, an online survey option will be available.

Questions

For Academy/AAOE assistance


Contact CMS

  • PQRS CMS Help Desk: 866.288.8912

Contacting Quintiles Outcome Registry

Practices that choose to report three individual PQRS measures or the Cataract Group Measure may choose use Quintiles Outcome as their CMS approved registry.




Registry Fees:
Reporting 3 Measures:
User Fee — $319.43
Submission Fee — $199
Total Cost Per Provider: $518.43
Cataracts Measures Group:
User Fee — $518.43
Submission Fee — $199
Total Cost Per Provider: $717.43

CMS 1500 Form Examples

Centers for Medicare & Medicaid Services (CMS) health insurance claim form examples for: